3D打印技术在先天性气管狭窄诊断与手术治疗中的应用

Application of 3D printing in the diagnosis and surgical treatment of congenital tracheal stenosis

目的评估3D打印技术在先天性气管狭窄外科治疗中的应用价值。方法回顾性分析我院2013年2月至2014年5月在3D打印技术指导下4例婴幼儿先天性气管狭窄的术前诊断、术中决策及术后随访的临床资料。其中男3例、女1例,平均年龄(23.0±7.1)个月,合并肺动脉吊带2例、室间隔缺损1例、法洛四联症1例。术前气管狭窄均经胸部CT及3D打印气管模型诊断,结合开胸前麻醉下气管镜检查确诊。术中先在体外循环下完成心脏畸形纠治,而后在平行循环下完成气管手术。气管手术方案的设计和实施由3D打印气管模型提供的数据和形态指导。气管主干长段狭窄2例,行Slide吻合;气管桥型狭窄2例,1例合并右下支气管开口狭窄者行扩大的Slide吻合,1例直接行端端吻合。结果全组患儿术前3D打印气管模型与气管镜检查及术中探查结果相符,术中气管镜证实气管狭窄完全纠治,吻合口对合完整,管腔通畅,无手术死亡,无重大并发症。术后随访1~2年,呼吸平稳,3D模型显示气管通畅。结论 3D打印技术能为先天性气管狭窄术前诊断和手术方案的设计、术中决策和操作提供很好的指导,提高气管狭窄手术治疗的成功率。

Objective To assess the application value of 3-dimensional（3D） printing technology in surgical treatment for congenital tracheal stenosis. Methods We retrospectively analyzed the clinical data of preoperative diagnosis, intra-operative decision-making and postoperative follow-up of four children with congenital tracheal stenosis under the guidance of 3D printing in our hospital between February 2013 and May 2014. There were 3 males and 1 female aged 23.0±7.1 months. Among them, two children were with pulmonary artery sling, one with ventricular septal defect, and the other one with tetralogy of Fallot. The airway stenosis was diagnosed preoperatively by chest CT scan and 3D printing tracheal models, and was confirmed by the help of bronchoscopy under anesthesia. During operation the associated cardiac malformation was corrected firstly under extracorporeal circulation followed by tracheal malformation remedy. The design and implementation of tracheal operation plans were guided by the shape and data from 3D printing trachea models. There were two patients with long segment of tracheal stenosis who received slide anastomosis. And the other two patients were characterized with tracheal bronchus, one of which combined ostial stenosis of right bronchial performed extensive slide anastomosis, and the other one performed end to end anastomosis. Results All the children’s preoperative 3D printing trachea models were in accord with bronchoscopy and intra-operative exploration results. Intra-operative bronchoscopy confirmed that all tracheal stenosis cured completely. All anastomotic stomas were of integrity, and all the luminals were fluent. There was no operative death or no serious complication. During 1-2 years follow-up, all patients breathed smoothly and their airways were of patency by postoperative 3D printing trachea model. Conclusion 3D printing can provide a good help to congenital tracheal stenosis in preoperative diagnosis, the design of operation plan, intra-operative decision-making and manipulation, which can improve the operation successful rate of tracheal stenosis.